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NPI Code Detail

MEDICARE: MR. MARK A. HENDLEY CASE MANAGER

MEDICARE: MR. MARK A. HENDLEY CASE MANAGER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1104988153
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK A. HENDLEY CASE MANAGER
Provider Business Mailing Address
First Line : 136 CANYON DR
Second Line :
City : RATON
State : NM
Zip : 87740-3756
Country : US
Telephone Number : 505-445-2754
Fax Number : 505-445-2225
Provider Business Practice Location Address
First Line : 220 4TH AVE
Second Line :
City : RATON
State : NM
Zip : 87740-2643
Country : US
Telephone Number : 505-445-2754
Fax Number : 505-445-2225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 07/08/2007

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